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Lecture 3

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Health Studies
Barakat- Haddad

Lecture 3 Oct 4/12 Outline  History of Hansen’s disease / Leprosy  Etiology  Epidemiology  Risk  Clinical manifestations  Diagnosis and treatment  Hansen’s Disease in Canada HISTORY  Dated in Egyptian Papyrus document (1550 BC)  Indian writings, approximately 600 BC  In records of ancient Greece, after the army of Alexander the Great returned from India (320 BC)  In Rome (62 BC) with the return of Pompeii's troops from Asia Minor  We don’t know much about it’s It is believed to have originated in the Far East approx. 1500-1400 B.C  It has been mentioned in many religious books (Bible) so it must have been very prevalent during that time  Believed to have spread to the Mediterranean area and Europe from far Asia o In Europe there’s evidence of diseases in bones dating back to 500 and 700 A.D.  Traditionally it was recognized as the “Disease of the soul” o Earlier thought to be a hereditary illness, or caused by a curse or by punishment from God o It was believed that those who had sinned had contracted the disease because of the sins they had made  Lepers were stigmatized and cast outside of society o The open sores contributed to the belief that they were contagious o The clinical manifestation of the disease gave the impression that people that had contracted leprosy were in fact contagious o Thus, the disease was very much feared and misinterpreted  E.g. lepers had to wear special clothing, arrival notification, treated in separate hospitals, and often had to live in colonies called leprosarium / lazaretto / leper colony / lazar house o In the 12 and 13 century it is believed that they were strapped to posts and often they were burned alive o In other places these people were buried alive  First ‘leper house’ in England 936 AD  Mid-12 century – loss of civic status, removal from public office o Massive separation was performed to take lepers out of their homes, towns, villages and into those leprosariums or lazar houses where they lived all together  Reached its peak some time in the 13 century - 19,000 ‘leprosaria’ in use  Mass of Separation  Decline around 1350 AD  By the 16 century a lot of the leprosariums were closed Europe th  By 18 century there were no leprosariums left in Europe  Spread to North America in the 16 and 17 centuries  In 1823 lepers were taken away and alienated to an island (Molokai Island)  American National Leprosarium was established in Louisiana in 1917 o Lepers were stigmatized and stereotyped Lecture 3 Oct 4/12 o Patients were not allowed to marry until 1952 in those leprosariums o In 1997 there were about 135 people that were released Mass of Separation ‘I forbid you to ever enter a church, a monastery, a fair, a mill, a market or an assembly of people. I forbid you to leave your house unless dressed in you recognizable garb and also shod. I forbid you to wash your hands or to launder anything or to drink at any stream or fountain, unless using your own barrel or dipper. I forbid you to touch anything you buy or barter for, until it becomes your own. I forbid you to enter any tavern; and if you wish for wine, whether you buy it or it is given to you, have it funneled into your keg. I forbid you to share house with any woman but your wife. I command you, if accosted by anyone while travelling on a road, to set yourself down- wind of them before you answer. I forbid you to enter any narrow passage, lest a passerby bump into you. I forbid you, wherever you go, to touch the rim or the rope of a well without donning your gloves. I forbid you to touch any child or give them anything. I forbid you to drink or eat from any vessel but your own.’ ETIOLOGY  Dr. Armauer Hansen of Norway – 1873  Discovers the leprosy germ under a microscope  Gave it the name Mycobacterium leprae (M. leprae ) THIS IS THE AGENT THAT CAUSES LEPROSY. o This disease cannot grow on tissue, it can only grow on mice pads and 9-banded armadillos  He did not believe that this disease was hereditary or caused by a curse  Leprosy is now also called Hansen's Disease  Leprosy is a chronic disease (goes on for a long period of time – progressive) and is caused by the microbacterium M. leprae  Slow multiplying bacillus o Average doubling time of 12 – 14 d  Long incubation period of 3 – 5 yrs  Thought to be transmitted via droplets, from the nose during close and frequent contact  Not highly infectious (low virulence) – may be related to genetic susceptibility (due to the clusters found in certain families)  Mainly affects the skin, nerves, and mucous membranes o Believed that the bacteria are shed by the skin mostly in the nasal secretions and if they enter via the nose or through an open wound they will attack certain nerve cells  Believed that there is a cross-protection between tuberculosis and leprosy o i.e. if a person gets leprosy they may be much less susceptible to contracting tuberculosis EPIDEMIOLOGY  There is a cyclical nature with this disease  This relates to the Rnot  There is a general decrease in the prevalence of this disease  Lecture 3 Oct 4/12 Year Prevalence Rate (2004)  Africa - 8 per 100,000  South East Asia - 24.6 per 100,000  Western Pacific - 0.7 per 100,000  Americas -10 per 100,000 PREVALENCE IN AFRICA
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